HomeMy WebLinkAboutHaas (2) OFFICE OF THE TOWN CLERK .c0f131,1(e,"
Town of SoutholdG
Judith T. Terry, Town Clerk ��
Town Hall, 53095 Main Road ' — ,„,t1
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P. 0. Box 1179 \v' a { .,
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Southold, New York 11971 ,Q •®:
Telephone _ Oj t
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit'No. 603 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: John A. Haas
OWNER MAILING ADDRESS: 1780 Ole Jule Lane
Mattituck. Flew York 11952
OWNER PROPERTY ADDRESS: 1780 Ole Jule Lane
Mattituck. New York 11952
OWNER TELEPHONE NUMBER: 516-298-4724
TAX MAP NO. : Section 122 Block 4 Lot 6
CROSS STREET: Kraus Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Ju iTth i . Te •
Southold Town Clerk -
DATE: February 11, 1988
-.(TOWN SEAL)
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OFFICE OF THE TOWN CLERK C§IFFO(,r `(o
Town of Southold ® _. C A lication No. O
Judith T. Terry, Town Clerk �►
Town Hall, 53095 Main Road o . ` : } Residential
P. O. Box 1179 cn s Non-Residential
Southold, New York 11971 O � `'"' *'•``
Telephone SO Lit
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �(�•
DATE7-4.11942(F)
•
OWNER NAME: TO h QS
OWNER MAILING ADDRESS: /? 70 0% -./V /e �n
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1-c) c N fl F Ls-`,),
OWNER PROPERTY ADDRESS: 1b'76 Ole J /e /--h e
OWNER TELEPHONE NUMBER: 516' olglf* C/71
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TAX MAP NO. : Section /01. Block 7 Lot — (D
CROSS STREET: /} ra.- /S ' J
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,c . /??7 (.?)
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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Sig '. .r re o , ' •p c. .
RECEIVED BY: 4ct
Townrk's -L)
DATE: / ��'�
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